Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204F00000X | Transplant Surgeon | L5701 | TX |
N | 208200000X | Surgeon | L5701 | TX |
N | 208600000X | Surgeon | L5701 | TX |
NPI | 1164498192 |
---|---|
Provider Name | Stephen Cheng |
First Address | Fort Worth, TX 76104-2191 |
Second Address | Fort Worth, TX 76104-2191 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/02/2006 |
Last Update Date | 02/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
158196902 | (05) | TX |
8H8674 | BC/BS (01) | TX |
F29326 | (02) | TX |